Key result
Caffeine citrate use was not associated with a statistically significant increased incidence of sustained tachycardia compared to alprostadil alone in neonates with ductal-dependent CHD (median 7 vs 4 events, p=0.293).
Why the study?
Alprostadil-induced apnoea in ductal-dependent CHD can be mitigated with caffeine citrate, but caffeine citrate can lead to potentially detrimental tachyarrhythmias.
Does caffeine citrate increase the frequency of sustained tachycardia in neonates with ductal-dependent CHD receiving continuous alprostadil infusions?
Cohort (n=150)
No
Does caffeine citrate increase the frequency of sustained tachycardia in neonates with ductal-dependent CHD receiving continuous alprostadil infusions?
In neonates with ductal-dependent CHD, adding caffeine citrate to alprostadil infusions to prevent apnea did not significantly increase the incidence of sustained tachycardia, though an unexpected increase in seizures warrants further investigation.
Caffeine citrate may be considered without clear tachycardia excess in these neonates; leaves open prospective confirmation in larger studies.
Neonates with ductal-dependent congenital heart disease (CHD) will receive a continuous infusion of a prostaglandin E1 analogue such as alprostadil prior to surgical correction. Alprostadil can cause apnoea, which may be mitigated in practice with the use of caffeine citrate. Caffeine citrate can lead to tachyarrhythmias, which could be detrimental in this patient population. The purpose of this study was to determine if the practice of utilising caffeine citrate in neonates with ductal-dependent CHD receiving continuous alprostadil infusions is safe. In this single-centre, retrospective, cohort study of neonates admitted to the congenital heart service from November 2017 to September 2024, patients were included if they had ductal-dependent CHD and a gestational age greater than or equal to 35 weeks. Neonates that received continuous infusion of alprostadil alone were compared to those that received alprostadil in addition to caffeine citrate. The primary outcome was the frequency of sustained tachycardia during treatment. Seventy-five patients were included for review in each cohort. The median number of incidences of sustained tachycardia per patient was 7 (interquartile range 1–20) in the alprostadil plus caffeine citrate group and 4 (interquartile range 0–18) in the alprostadil alone group ( p = 0.293). Other arrhythmias during the treatment course were common and similar between each cohort. Utilising caffeine citrate was not associated with a statistically significant increased incidence of tachycardia in neonates with ductal-dependent CHD on alprostadil infusions at the University of Florida.
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Mace et al. (2026) conducted a cohort in Ductal-dependent congenital heart disease (CHD) (n=150). Caffeine citrate vs. Alprostadil alone was evaluated on Frequency of sustained tachycardia during treatment (median number of incidences per patient) (p=0.293). Caffeine citrate use was not associated with a statistically significant increased incidence of sustained tachycardia compared to alprostadil alone in neonates with ductal-dependent CHD (median 7 vs 4 events, p=0.293).
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